Female Reproductive Health

Ovarian Cysts - Causes, Types, Symptoms and Treatments

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20 June 2022 at 16:03 BST
First published

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Ovarian Cysts are extremely common and usually form during ovulation. Most ovarian cysts occur naturally and go away in a few months without needing any treatment.

However, about 8% of premenopausal women develop large cysts that need treatment.

What is an ovarian cyst?

A cyst is a solid or fluid-filled sac and can form in different areas of our bodies. As the name suggests, ovarian cysts form in or on the ovaries.

How common are Ovarian Cysts?

Ovarian cysts are very common in women. In fact, most women make at least one follicle or corpus luteum cyst every month.

Cysts do not usually cause any symptoms so you may not be aware that you have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form

How many types of Ovarian Cysts are there?

There are five types of ovarian cysts. The two most common ones are:

Functional ovarian cysts
Pathological ovarian cysts

Other types of benign ovarian cysts are:

Endometriomas
Dermoids
Cystadenomas

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What are the types of Ovarian cysts?

Functional cyst:

Most ovarian cysts are functional cysts. This means that they develop as part of your usual menstrual cycle.

Each month, your ovary produces several follicles (tiny fluid-filled sacs). One of these will mature and release an egg. After releasing the egg, the follicle normally changes into something called the corpus luteum. The corpus luteum releases hormones that help the lining of your uterus (womb) prepare for pregnancy. If the egg isn’t fertilized, the corpus luteum begins to break down.

The two main types of functional cyst form at different stages in this cycle.

Follicular cyst: this can happen if a follicle doesn’t release an egg but carries on growing.
Corpus luteum cyst: can form if the corpus luteum doesn’t break down. It may continue to grow and become filled with blood.

What’s the size of a Functional Cyst?

Most functional cysts are 2 to 5 centimeters (cm)in size. Ovulation happens when these cysts are around 2 to 3 cm in size. However, some may reach sizes of 8 to 12 cm.

Pathological cyst

These may happen because of an overgrowth of cells. You may hear these types of ovarian cysts referred to as ‘tumors’, but this doesn’t necessarily mean that they’re cancerous. Most aren’t.

What’s the size of a Pathological Cyst?

Pathological cysts often grow slowly, at about 1.8 mm per year. However, studies have reported that some dermoid cysts can grow more rapidly, between 8 and 25 mm per year. In rare cases, giant dermoid cysts over 15 cm (about 6 inches) in diameter have been reported.

Endometriomas Cyst

Endometriomas are caused by endometriosis. Endometriosis happens when the lining of the uterus (womb) grows outside of the uterus.

What’s the size of an Endometriomas Cyst?

It’s estimated that between 17% and 44% of women with endometriosis will develop an Endometrioma cyst, which is typically small, but like other cysts, they can come in a range of sizes.

Dermoid Cyst

Dermoids come from cells present from birth and do not usually cause symptoms.

Cystadenomas Cyst

Cystadenomas are filled with watery fluid and can sometimes grow large. In some women, the ovaries make many small cysts. This is called polycystic ovary syndrome (PCOS). PCOS can cause problems with the ovaries and with getting pregnant.

When do ovarian cysts become cancerous?

Some ovarian cysts can become cancerous, but malignant (cancerous) cysts are rare. However, the risk of ovarian cancer increases as you get older. Women who are past menopause with ovarian cysts have a higher risk for ovarian cancer.

How do ovarian cysts affect fertility?

Ovarian cysts do not usually prevent you from getting pregnant, although some ovarian cysts are associated with decreased fertility such as Endometriomas and cysts from polycystic ovarian syndrome (PCOS)). Functional cysts, dermoid cysts, and Cystadenomas are not associated with difficulty in getting pregnant unless they are large.

Most cysts are benign and do not require surgical intervention. However, if the cyst is suspicious for cancer or if the cyst ruptures or twists (known as torsion), or is too large, you may need to remove it surgically.

In this case, your surgeon will aim to preserve your fertility whenever possible. This may mean removing just the cyst and leaving the ovaries intact, or only removing 1 ovary.

What causes an Ovarian cyst?

The most common causes of ovarian cysts include:

Hormonal problems: Functional cysts are usually caused by hormonal problems or drugs used to support ovulation. They usually go away on their own without treatment and are not cancerous.
Endometriosis: Women with endometriosis can develop a type of ovarian cyst called an Endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
Pregnancy: An ovarian cyst normally develops in early pregnancy to help support the pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later in the pregnancy and may need to be removed.
Severe pelvic infections: Infections can spread to the ovaries and fallopian tubes and cause cysts to form.

What are the symptoms of Ovarian Cysts?

Most ovarian cysts are small and don't cause symptoms. However, if a cyst does cause symptoms, you may experience:

Dull or sharp pain on one side of your lower abdomen
Pressure in your abdomen
Abdominal bloating or swelling

Less common symptoms include:

Pelvic pain
Dull aches in the lower back and thighs
Problems emptying the bladder or bowel completely
Pain during sex
Unexplained weight gain
Pain during your period
Irregular periods
Unusual (not normal) vaginal bleeding
Breast tenderness
Feeling like you have to urinate frequently

If a cyst ruptures, it can cause sudden, severe pain.

If a cyst causes twisting of an ovary, you may have pain along with nausea and vomiting.

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What does ovarian cyst pain feel like?

Depending on the type of cyst, the pain from ovarian cysts may feel sharp or dull. You may feel pain for extended periods of time, or it may come and go.

Pain caused by cysts will tend to be stronger during your period as the hormones produced during this time may cause the cyst to enlarge, triggering pain.

How are ovarian cysts diagnosed?

Because most ovarian cysts don't cause any symptoms, you may only find out you’ve got one if you’re having tests such as an ultrasound scan or during a routine pelvic exam with your GP.

Your doctor can detect an ovarian cyst during a routine pelvic examination. If they notice on your ovaries, they may decide to order an ultrasound to help determine the size, location, shape, and composition (solid or fluid filled) of a cyst.

Some of the tests they may suggest are:

Transvaginal ultrasound – an ultrasound probe placed into your vagina to produce a clear picture of your ovaries.
Transabdominal ultrasound – a scan over your lower abdomen to check for any problems around your pelvic area.
Blood tests – to help rule out cancer, including a test for a substance called CA-125. Your level of CA-125 can be high if you have ovarian cancer, but it may also be raised due to other conditions.

However, as the majority of cysts disappear after a few weeks or months, your doctor may not immediately recommend a treatment plan. Instead, they may repeat the ultrasound test in a few weeks or months to check your condition.

Depending on the results, your GP may refer you to a gynecologist (a doctor who specializes in women’s reproductive health).

Ovarian cyst treatment

Your doctor may recommend treatment to shrink or remove the cyst if it doesn’t go away on its own or if it grows larger.

Birth control pills

If you have recurrent ovarian cysts, your doctor can prescribe oral contraceptives to stop ovulation and prevent the development of new cysts.

Oral contraceptives can also be used to treat other reproductive conditions such as endometriosis. However, they do come with other side effects.

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Removing small ovarian cyst: Laparoscopy

If your cyst is small and results from an imaging test rule out cancer, your doctor can perform a laparoscopy to surgically remove the cyst.

The procedure involves your doctor making a tiny incision near your navel and then inserting a small instrument into your abdomen to remove the cyst.

Removing large ovarian cyst: Laparotomy

If you have a large cyst, your doctor can surgically remove the cyst through a large incision in your abdomen.

During the laparotomy, they’ll conduct an immediate biopsy, and if the cyst is cancerous, they may perform a hysterectomy to remove your ovaries and uterus.

What happens if an ovarian cyst ruptures?

According to Dr. Dana Baras, M.D., M.P.H., an obstetrician/gynecologist at Howard County General Hospital, a ruptured ovarian cyst isn’t necessarily a life-threatening condition.

“In the majority of cases, the cyst fluid will dissipate and it’ll heal without any intervention.”

“Not all women feel a ruptured ovarian cyst,”.“Most do feel pain at the time of rupture and then some discomfort for a few days afterward. Usually, the symptoms can be relieved with over-the-counter medications.”

Symptoms you may experience if you have a ruptured ovarian cyst include:

Sudden, sharp pain in the lower belly or back
Vaginal spotting or bleeding
Abdominal bloating

“However, there are some instances in which a ruptured ovarian cyst becomes an emergency.”. Seek emergency medical attention if you also have abdominal pain with: